Putting Your Best Foot Forward
Believe it or not, in Arizona this week our temperatures are already over 90 degrees. Yes, summertime is virtually here, and it is time to break out the sandals, get ready to relax at the beach, and enjoy pool parties. No matter how you plan to spend it, regardless of whether you are male or female, young or old, your feet are sure to be noticed. Are your feet ready?
Great feet is not just about how pretty they are, as a Certified Reflexologist and Perscentoelogist, I understand the importance of taking quality care of your feet. Believe it or not, beauty starts with the feet. Hence the saying put your best foot forward. The most beautiful face will show the strain of tired, aching feet. They will also cause a loss of balance in your walk and promote tension and irritability. If your feet are out of alignment, your entire skeletal system will be out of alignment and this may place a great deal of strain on your muscles and ligaments.
While taking care of your feet is important all year long, many of us have an out of sight out of mind attitude. Summertime is a reminder to bring your feet out into the open and pay them some extra special attention. I believe in this so much, that if I could only have one spa treatment, I would choose a pedicure.
Twenty Fun Foot Facts
While these foot facts are fun and interesting, they point out how important it is to take great care of your feet. Many maladies of your feet may point to more substantial health problems. If ignored, a few of these conditions can create debilitating and life-threatening conditions.
- Three out of four Americans will experience foot health problems of varying degrees of severity at one time or another in their lives.
- There are approximately 250,000 sweat glands in a pair of feet, and they excrete as much as half a pint of moisture each day.
- The foot is an intricate structure containing 26 bones. Thirty-three joints, 107 ligaments, 19 muscles, and tendons hold the structure together and allow it to move in a variety of ways.
- The 52 bones in your feet make up about one-quarter of all the bones in your body.
- Women have about four times as many foot problems as men; lifelong patterns of wearing high heels often are the culprit.
- The American Podiatric Medical Association says the average person takes 8,000 to 10,000 steps a day. Those cover several miles, and they all add up to about 115,000 miles in a lifetime — more than four times the circumference of the globe.
- There are times when you’re walking that the pressure on your feet exceeds your body weight, and when you’re running, it can be three or four times your weight.
- Your feet mirror your general health. Such conditions as arthritis, diabetes, nerve, and circulatory disorders can show their initial symptoms in the feet. Foot ailments can be your first sign of more serious medical problems.
- Arthritis is the number one cause of disability in America. It limits everyday dressing, climbing stairs, getting in and out of bed, or walking – for about 7 million Americans.
- About 60-70% of people with diabetes have mild to severe forms of diabetic nerve damage, which in severe forms can lead to lower limb amputations. Approximately 56,000 people a year lose their foot or leg to diabetes.
- Only a small percentage of the population is born with foot problems, the American Podiatric Medical Association believes. It is neglect, and a lack of awareness of proper care — including ill-fitting shoes — that bring on the problems. A lifetime of wear and tear, plus neglect, accounts for the fact that the practices of most podiatrists are made up of older Americans.
- Corns and calluses are caused by friction and pressure from skin rubbing against bony areas when wearing shoes. If the first signs of soreness are ignored, corns and calluses rise up as nature’s way of protecting sensitive areas.
- Plantar warts are caused by a virus that may invade the sole of the foot through cuts and breaks in the skin. Walking barefoot on dirty pavements or littered ground can expose feet to this sometimes painful skin infection.
- About 19 percent of the US population has an average of 1.4-foot problems each year.
- About 5 percent of the US population has foot infections, including athlete’s foot, other fungal infections, and warts each year.
- About 5 percent of the US population has ingrown toenails or other toenail problems each year.
- About 5 percent of the US population has corns or calluses each year. Of the three major types of foot problems (infections, toenails, and corns and calluses), people are less likely to receive treatment for corns and calluses and more likely to continue to have corns and calluses as a problem without treatment.
- About 6 percent of the US population has foot injuries, bunions, and flat feet or fallen arches each year.
- About 60 percent of all foot and ankle injuries, reported by the US population older than 17, were sprains and strains of the ankle.
- As a person’s income increases, the prevalence of foot problems decreases.
- Podiatric physicians provide treatment for 82 percent of corn and callus problems, 65 percent of toenail problems, 63 percent of bunion problems, 46 percent of flat feet or fallen arches problems, and 43 percent of toe/joint deformities.
- Eighty percent of the population will suffer from back pain due to a problem starting in their feet. This can be caused by biomechanical imbalances, abnormal stresses or structural problems
Sole Survival … solving your foot problems
The word bunion is from the Latin “bunion,” meaning enlargement. A bunion is generally considered as an enlargement of the joint (a lump of bone) at the base and side of the big toe – (specifically, the first metatarsophalangeal joint). Bunions form when the toe moves out of place. As the big toe bends towards the others this lump becomes larger and the bunion can become painful – arthritis and stiffness can eventually develop. Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe and a bunion refers to the enlargement of the joint-most of the time the two go together and can just be referred to as ‘bunions’.
What are the symptoms of bunions?
Bunions start as the big toe begins to deviate, developing a firm bump on the inside edge of the foot, at the base of the big toe. Initially, at this stage, the bunion may not be painful. Later as the toes deviate more the bunion can become painful – there may be redness, some swelling, or pain at or near the joint. The pain is most commonly due to two things – it can be from the pressure of the footwear on the bunion or it can be due to an arthritis-like pain from the pressure inside the joint. The motion of the joint may be restricted or painful. A hammertoe of the second toe is common with bunions. Corns and calluses can develop on the bunion, the big toe and the second toe due to the alterations in pressure from the footwear. The pressure from the great toe on the other toes can also cause corns to develop on the outside of the little toe or between the toes. The change in pressure on the toe may predispose to an ingrown nail.
What causes a bunion?
Wearing footwear that is too tight or causing the toes to be squeezed together is the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor. This probably is the reason for the higher prevalence of bunions among women. However, studies of some indigenous populations that never wear footwear show that they also get bunions. As they do get bunions, factors other than footwear must play a role in the cause, even though footwear is the main culprit for providing the pressure that causes the symptoms.
Bunions are most widely considered to be due to an imbalance in the forces that are exerted across the joints during walking. The resulting abnormal motion and pressure over the joint, over many years (combined with poor fitting footwear) leads to instability in the joint causing hallux valgus and bunions. Bunions are really only a symptom of faulty foot mechanics and are usually caused by a combination of the way we walk, the foot we inherit, and inappropriate footwear use.
Bunions are not inherited but do tend to run in families. What is inherited is the poor or faulty foot type, that mechanically can lead to the instability around the joint that will eventually lead to bunions – how soon, how quickly and how bad they are or become is assumed to be very dependent on the footwear.
A number of other factors are known to play a role in the cause of bunions and hallux valgus. Bunions can follow foot injuries and develop in those with neuromuscular problems. Those with flat feet or pronated feet appear to be more prone to the instability about the joint and have a higher incidence of bunions. Some activities (eg ballet dancing) puts added pressure on the joint and may increase the chance of bunions developing. Other causes are weak ligaments in the feet and trauma or injury to afoot.
How are Bunions treated?
There are many treatment options for bunions and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms. Bunions are almost always progressive and tend to get larger and more painful with time – how fast this happens maybe a function of the fit of the footwear.
The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective may be “get rid off” a bunion without surgery. There are a number of things that individuals (see below) and Podiatrists can do to help the symptoms and slow (if not halt) progression.
What can you do yourself for bunions?
1. Follow the advice given by a Podiatrist
2. Use felt pads to help keep pressure off the painful area of the bunions.
3. Wear shoes that are wide and deep to accommodate the bunions. Fitting of footwear is very important. Avoid the use of high heel shoes.
4. Use exercises (see below) to keep the joint mobile
5. Night splints may help with the bunion symptoms (see below). The aim of these is to hold the toe in a more correct position.
Padding or foam between the big toe and the second toe is sometimes recommended – it should, generally, not be recommended as the big toe is usually so strong it just further ‘squeezes’ the lesser toes and can lead to problems between these toes. The padding between the two toes will not straighten the big toe. However, sometimes the padding may be needed to help with symptoms that originate inside the joint if the bunion is painful.
Are there exercises for bunions?
Keeping the joint mobile is important as this goes a long way to helping and prevent arthritic type pain that can develop inside the joint of those with bunions. Several exercises are recommended:
1. Grasp the big toe with one hand and do some ‘yoga’ like stretches on the joint in all directions. Hold the position at the end range of motion for 10-15 seconds. Repeat several times in all directions.
2. Traction helps some people with spinal problems, and can also help keep the big toe joint mobile. Grasp the toe and the foot and try and “pull” the toe “off”. Hold for 10-15 seconds. Repeat several times.
3. Find some sort of elastic band and loop it around both big toes. Spread your feet so that the toe is “straightened” – hold for several minutes. Repeat several times.
Exercises will NEVER be able to correct the position of the toe due to the adaption of bone that has gone on for many years as the bunion developed, but they are important to keep the toe flexible and mobile.
Will a night splint help a bunion?
Wearing splints at night have been shown to provide some correction in adolescents with hallux valgus or bunions (where they are young enough for the bone to still adapt). Read about this evidence here. They may not be as effective in adults but could be useful to help keep the joint mobile. As a bunion (hallux valgus) is a bony abnormality, it is much harder to change the position of a toe permanently in adults.
How do shoes aggravate bunions?
As footwear plays such an important role in the development and symptoms of bunions, proper fit is vitally important. It is poor fitting footwear in combination with the other factors mentioned above which is the cause of bunions. Footwear also provides the force that makes them painful – the use of the correct footwear is your responsibility.
Is there a surgery to correct Bunions?
If the bunion symptoms do not respond to the conservative measures or if the bunion has progressed past a threshold where these measures are not effective, bunion surgery may be necessary to correct alignment and remove the bunion. A large range of types of surgical procedures for bunions are available and the choice will depend on things like what bone or bones are involved, the angular relationship between the different bones, the amount of damage to the joint, and the presence of deformities other than the bunion.
Calluses (keratomas or tylomas) can develop on any part of the body and are caused by repeated friction and pressure. These areas of thickened skin do not have distinct borders and are formed to protect the skin and the structures behind it from injury or damage. Musicians, especially those that play stringed instruments and other people who work with their hands often develop calluses that help protect their fingers and palms.
On the feet, calluses typically develop on the plantar surface where there is usually the most pressure and friction from standing and walking. These areas of pressure are usually the sole, heel, or on the metatarsal heads where the inner bones of the toes connect to the foot. As calluses thicken, pain may develop from excess pressure against the skin.
Calluses may be painless or may include burning or throbbing. An infected callus may produce pus-like drainage from the callus, pain, swelling, and even fever. This can be treated with antibiotics. Diabetics should seek medical treatment for all foot abnormalities, including calluses.
What are the causes of calluses?
Excessive pressure on a specific area of the foot cause calluses. A few common causes of calluses are wearing high-heeled dress shoes, shoes that are too small, obesity, flat feet, high arched feet, bony prominence, abnormalities in the gait cycle (walking motion), and the loss of the fat pad on the bottom of the foot.
What is the treatment of calluses?
Diagnosis is usually based on a physical examination. X-rays help detect abnormalities within the bony structure of the feet that may be the cause of calluses. A biopsy may be ordered where skin cells are removed and examined under a microscope.
Some people try to alleviate pain themselves by cutting or trimming their calluses with a razor blade or knife. This is not the proper way to treat calluses because it is very dangerous and can worsen the condition resulting in unnecessary injuries. People with diabetes should never try this type of treatment.
As corns and callus are symptoms of underlying problems, self-treatment should follow a proper diagnosis of the underlying condition and advice on how to best manage it.
Remedies such as corn paint, cure, or plasters will generally only treat the symptom of the corn and not the problem that causes it. These chemicals contain acid that is supposed to ‘eat away’ the corn, but the chemical cannot tell what is corn and what is normal – it will eat whatever you put it on. While this can be risky in healthy people, it can be very dangerous and risky in those with poor circulation and/or diabetes. The use of “corn plasters” in those who are at risk or have frail skin is very likely to cause an ulcer (a breakdown of the skin) which could become infected and it the circulation is poor, an amputation is a possibility.
Cutting corns or calluses yourself (bathroom surgery) is not without its dangers, especially if you cut yourself. In the warm and moist environment of enclosed shoes, an infection can easily develop into a serious wound.
Self-treatment or management of corns and callus includes:
- following the advice of a Podiatrist
- proper fitting of footwear
- proper foot hygiene and the use of emollients to keep the skin in good condition
Corns are formed over areas that are frequently exposed to pressure and friction. These are thickened layers of skin that the body has formed in an attempt to protect the skin and its’ inner layers from outside pressures. Corns can be hard or soft with a translucent center. The hard corns are found mainly on the top, tip, or side of toes where constant pressure is applied. Soft corns are usually found between the toes. They can become inflamed and quite painful with repetitive pressure in the same areas. This can be caused by two toes constantly rubbing against each other, or it can be caused by the footwear rubbing against the toes. Like calluses, corns are compacted dead skin cells that have formed a thickened and hard shell. The pressure to the central core may stimulate the nerve below and cause pain and discomfort.
What Causes Corns?
Corns are caused by friction and pressure from the skin rubbing against bony areas when wearing shoes. If the first signs of soreness are ignored, corns and calluses can arise as nature s way of protecting its sensitive areas. In diabetic patient or those with a decrease in immune response, pressure areas may lead to ulcers instead of corns and calluses.
What is the treatment of Corns?
Avoid using corn removing solvents and medicated pads. These can cause further irritation and pain. Diabetics and individuals with poor circulation should never use any chemical agents to remove corns. This may lead to more serious problems such as ulcers and infections.
How can I prevent Corns from coming back?
Prevention of foot corn (hyperkeratosis):
Corns are easy to prevent – just take away the cause and that cause is excessive pressure. No chemical applied to the corn will take away the pressure. Correct fitting of footwear around the toes, the use of pads to relieve pressure, surgical management of bony prominence, and/or regular podiatric care are the best options for the prevention of corns.
Dry Cracked Heel
Cracked heels are a frequent problem found around the rim of the heel in women more than men. The cracks may be superficial or deep involving different layers of the skin. The skin on the soles of the foot and palms of the hands has a 5th layer which is one layer more than the rest of the body. This layer is called the Stratum Lucidum. This is a layer to add density to protect the palms and soles. If your heels start to bleed there is a risk of serious infection. Genetic factors may increase this risk of infection such as diabetes, anemia, immunosuppressed individuals.
What are cracked heels?
Cracked heels are a common foot problem that is often referred to as heel fissures. Cracked heels are commonly caused by dry skin (xerosis), and made more complicated if the skin around the rim of the heel is thick (callus). For most people, this is a nuisance and a cosmetic problem but when the fissures or cracks are deep, they are painful to stand on and the skin can bleed – in severe cases, this can become infected.
What does a cracked heel look like?
The skin is normally dry and may have a thick callus which appears as a yellow or dark brown discolored area of skin, especially along the inside border of the heel. Cracks in the skin are usually obvious.
What are the symptoms of cracked heels?
If the cracks are bad enough there will be pain on weight-bearing that is not there when weight is off the heel. The edges or rim around the heel will generally have a thicker area of skin (callus). Wearing open or thin-soled shoes usually make the symptoms worse.
What causes cracked heels?
Some people tend to have a naturally dry skin that predisposes them to the cracks. The thickened dry skin (callus) around the heel that is more likely to crack is often due to mechanical factors that increase pressures in that area. This could be caused by the way you walk. Other factors that cause cracked heels are:
- obesity – being overweight (this increases the pressure on the normal fat pad under the heel, causing it to expand sideways – if the skin is not supple and flexible, the pressures to ‘crack’ are high)
- decreased eccrine (sweat) gland function.
- men and women who walk barefooted or in open-backed shoes and sandals.
- prolonged standing (at work or home, especially on hard floors)
- open back on the shoes (this allows the fat under the heel to expand sideways and increases the pressure to ‘crack’)
- some medical conditions predispose to a drying skin (eg autonomic neuropathy in those with diabetes leads to less sweating; an underactive thyroid lowers the body’s metabolic rate and there is a reduction in sweating, leading to dryness of the skin)
- skin conditions (eg psoriasis and eczema)
What can I do to self treat cracked heels?
Applying an oil-based moisturizing cream twice daily is really important to get on top of this problem. A pumice stone can be used to reduce the thickness of the hard skin. After looking at the ‘tomato’ analogy above it should be obvious why it is important to avoid open-backed shoes or thin-soled shoes.
Never try to reduce the hard skin your self with a razor blade or a pair of scissors. There is a risk of an infection developing and taking too much off.
What podiatric management is done for cracked heels?
The podiatric treatment of cracked heels may involve the following:
- investigating the cause of the problem, so this can be addressed
- removing the hard thick skin by debriding it (often the splits will not heal if the skin is not removed). This may need to be done on a regular basis. Regular maintenance may be the best way to prevent the problem.
- if very painful, strapping may be used to ‘hold’ the cracks together while they heal (a maintenance program after this to prevent recurrence is very important).
- prescription and advice regarding the most appropriate moisturizer or emollient.
- advice about footwear and self-care of the problem.
- insoles may be used to alter the way you walk to prevent the thick skin from developing (these are indicated in cases of heel callus and are not suitable for all cases).
- a heel cup may be used to keep the fat pad from expanding sideways. This is worn in the shoe and can be very effective at prevention if used regularly.
- on rare occasions, some Podiatrists and Dermatologists have used a tissue ‘glue’ to hold the edges of the skin together, so the cracks can heal.
Nail fungus, or onychomycosis, is a condition that occurs when a microscopic fungus enters either a fingernail or toenail. Fungal infections occur in toenails more often than in fingernails.
Fungal Infections often cause the end of the nail plate to separate from the nail bed. Debris (white, green, yellow, or black) may build up under the nail plate and discolor the nail bed. The top of the nail or the skin at the base of the nail can also be affected. Toenails are more susceptible to fungal infections because they are confined in a warm, moist environment. This makeup approximately 50 percent of all nail disorders and can be difficult to treat. Candida or yeast infections are common in fingernails, especially if the hands are always in water or if the person has diabetes. Anyone can get nail fungus, but infections are more common in people over the age of 60. Nail fungus is especially common in people with diabetes or circulation problems. For people who have diabetes or a weakened immune system, nail fungus can present serious risks.
What Causes Nail Fungus?
Usually, nail fungus occurs when the fungus enters the nail through a small trauma (cut or break) in the nail. Nail fungus is not caused by poor hygiene. Nail fungus can be spread from person to person. If you notice an infected nail, don’t pick at it or even trim it, as both of these activities can cause the fungus to spread. It may be hard to determine exactly where or how a fungal infection is obtained. However, a warm, wet place (for example, a locker room) is a good place for a fungus to grow.
What Are the Symptoms of Nail Fungus?
A nail fungus infection can make your nails thick and discolored. Uncommonly, you may feel pain in your toes or fingertips.
How Is Nail Fungus Diagnosed?
Your doctor may be able to tell if you have a nail fungus infection by looking carefully at your nails. He or she may scrape some tissue from your nail and send it to a lab in order to determine for certain what kind of infection you have.
How Is Nail Fungus Treated?
Treatment may include topical creams or oral medications (antifungal drugs), but topical antifungal agents may only help treat very mild cases. Rarely, surgery may be required. Removal of the infected nail can be performed to permit the direct application of a topical antifungal. Because the fungus grows slowly, it can be hard to eliminate. Anti-fungal medications are available to combat fungal infections; however, they are strong oral medications that must be taken consistently for months in order to be effective. The medications also have potential side effects on other body organs (especially the liver, skin, and/or bone marrow).
To monitor side effects your physician must order periodic blood tests (usually monthly) during treatment. Any of the symptoms (listed below) suggesting organ damage should be reported immediately to your physician.
• Unusual fatigue
• Severe loss of appetite
• Yellow eyes
• Dark urine
• Pale stool
• Skin rashes
• Enlarged lymph glands
• Signs of infection
Unfortunately, anti-fungal creams applied to the nail do not penetrate the nail bed to kill the fungus at its source and are generally ineffective.
Toenail infections are more difficult to treat than fingernail infections because the toenail grows more slowly. In addition, a damp, warm environment of a shoe or boot can encourage fungal growth.
How Can I Prevent Getting Nail Fungus?
- Avoid walking barefoot in public areas, such as locker rooms
- Keep the inside of your shoes dry and change your socks frequently (100% cotton socks are recommended)
- Wear proper-fitting shoes (shoes with a wide toe area and ones that don’t press your toes)
- Use absorbent or antifungal powder
A hammertoe is a toe that is contracted at the PIP joint which is the middle joint in the toe. This can potentially lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards.
There can be rigid or flexible hammertoes. Rigid ones are more severe because movement in the toe is very limited or nonexistent and is accompanied by pain and pressure on the top of the toe as well as the bottom of the ball of the foot where corn or callus may develop. Flexible hammertoes can be straightened out manually but possess a tendency to contract if left alone.
What Causes Hammer Toes?
Hammertoes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joint curling downward. Arthritis can lead to many different forefoot deformities including hammertoes. Hammer digit syndrome contributes to the downwards pushing of the metatarsal bones which creates either a capsulitis or constant irritation to the metatarsals. The curling up of toes causes the natural fat pad to move forward promoting fat pad atrophy through disuse or thinning out until they are no longer able to support the foot and protect it against abnormal pressures. Tight footwear is an important factor in the cause of hammertoes as well as providing the pressure that causes the symptoms
What is the treatment for Hammer Toes?
Changing the type of footwear worn is a very important step in the treatment of hammertoes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammertoes. A shoe with a high, broad, toe box will provide enough room in the forefoot area so that there is less friction against the toes on the top of the toes.
Other conservative treatments include using forefoot products designed to relieve hammertoes, such as hammertoe crests and hammertoes splints. These devices will help hold down the hammertoe providing relief. Gel toe shields and gel toecaps are also recommended to eliminate friction between the shoe and the toe while providing comfort and lubrication.
Treatment for hammertoes depends on the severity of the deformity. When the toes first start to buckle, they can be straightened easily. If the problem is caused by flat feet, a podiatrist can fit the patient for custom-molded orthotics that provide better arch support so the muscles work better together.
Without treatment, the soft tissues attaching to hammertoes and claw toes tighten by laying down adhesions that stick to the tendons and joint capsules to produce a rigid deformity. If this happens, surgery is usually required for adequate correction of the toe.
Arthroplasty is a minor surgical procedure that lengthens a shortened toe muscle. In this procedure, the podiatrist or surgeon makes an incision along the toe and trims the head of the proximal phalanx to straighten the toe.
If the affected toe still does not straighten sufficiently after arthroplasty, the podiatrist or surgeon can use a variety of progressive procedures to achieve the desired result.
If the toe will still not straighten, there is one final procedure that may restore normal mobility called an arthrodesis. This is the fusing of two bones, the middle and proximal phalanges. The surgeon removes the cartilage and bone from these two bones and presses them together where they meet. A temporary removable pin may be employed to ensure prompt fusion and good alignment.
These procedures require the patient to stay off his or her feet for several weeks. This may be inconvenient for a time, but with proper postoperative care, the patient can obtain the desired relief.
Heel pain is often caused by poor foot mechanics. A sudden increase in athletic activity, such as running, walking, or even gardening can create a strain on the foot. This usually affects the plantar fascia, the ligament that runs from the heel bone to the front of the foot. When this ligament becomes irritated due to strain or overuse it can cause heel pain due to inflammation. Heel pain is the fastest-growing foot problem in America. Fortunately, there are new treatments for this condition that can make heel pain of the past.
There are many forms of foot pain, but heel pain can be one of the most troubling. The most common form of heel pain in people is known as “Heel Spurs” or “Plantar Fasciitis” (pronounced PLAN-tar fashee-EYE-tiss). Many resources label them one and the same, however, heel spurs and plantar fasciitis are slightly different.
Plantar Fasciitis occurs when the long, flat ligament on the bottom of the foot (Plantar Fascia) stretches irregularly and develops small tears that cause the ligament to become inflamed. The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia.
A Heel Spur is actually a type of bone growth that develops on the outside of the heel bone where the plantar fascia ligament attaches. Spurs may form when the plantar fascia becomes inflamed causing calcification or bone growth. They are often described as having a small hook shape to them, which causes pain by irritating the surrounding soft tissue.
Although the plantar fascia is invested with countless sturdy ‘cables’ of connective tissue called collagen fibers, it is certainly not immune to injury. In fact, about 5 to 10 percent of all athletic and exercise injuries are inflammations of the fascia, an incidence rate that in the United States would produce about a million cases of plantar fasciitis/heel spurs per year. Middle-aged, overweight, and athletic individuals are more prone to plantar problems, as are non-athletic people who spend a lot of time on their feet or suddenly become active after a long period of lethargy. A recent study found that over 50 percent of people who suffer from plantar fasciitis are on their feet nearly all day.
Plantar fasciitis and heel spur usually develop gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain. In some cases, the inflamed ligament may not heal because many people who are developing the conditions do not completely stop the aggravating activity.
A number of factors are directly associated with the development of plantar fasciitis and heel spurs. These factors can lead to the change of the gait (the way the feet strike the ground), which can cause additional injury.
Risk factors for include:
Biomechanical factors, such as decreased flexibility in the foot and ankle, imbalances in muscle strength (muscles in one leg or foot are weaker than the other), abnormal foot mechanics (when stepping down), and tightness in the Achilles tendon.
- The repetitive nature of sports activities and improper training.
- Sudden increases in weight.
- Rapidly increasing the length of time spent on the feet.
- Running or walking up steep hills.
- Wearing shoes that are worn out.
- Wearing shoes that do not have a cushioned sole or enough arch support.
- Abruptly changing the intensity or duration of athletic activities.
The traditional remedies for plantar fasciitis include stretching the calf, massaging, decreasing one’s activities, losing weight, purchasing better-fitting shoes (with a raised heel and arch support), icing the sore heel, and taking ibuprofen. The most common treatment is one of the most basic, a heel cup or pad. Such devices can eliminate the condition and help you regain your mobility without the need for expensive and complicated remedies.
Ingrown toenails can occur when the corner or side of the nail grows into the flesh of the toe. In many cases, ingrown nails occur in the big toe. The end result of this common condition is pain, redness, and swelling. Infection can occur in some cases.
What Causes Ingrown Toenails?
Some common causes of ingrown toenail include cutting the nails too short or not straight across, injury to the toenail, and wearing shoes that crowd the toenails. Other common causes are:
The most common causes are:
- improperly cut toenails
- poorly fitted shoes
- unusually curved toenails
- trauma to the nail
- to the toe
How Can Ingrown Toenails Be Treated?
In mild cases, ingrown toenails may be treated with a 15-20-minute soak in warm water. Dry cotton can be placed under the corner of the nail. Talk to your doctor if you are experiencing increasing pain, swelling and drainage of the area. If the tissue around the nail is infected, your doctor will prescribe an antibiotic. Minor surgery can be performed to remove the part of the nail that is poking into the skin.
How Can Ingrown Toenails Be Prevented?
- You can prevent ingrown toenails by:
- Wearing shoes that fit properly
- Keeping your toenails at a moderate length and trimming them straight across
- Wearing protective footwear
Perspiration Causes Foot Odor
Feet have 250,000 sweat glands and can produce as much as 4 ounces of perspiration in one day. This however does not cause foot odor. Foot odor is caused from bacteria on your feet and in your shoes. To eliminate the odor, you must kill the bacteria. If your feet are also red, swollen or scaly see your doctor in case the smell is actually being caused by a bacterial or fungal infection
How can I keep my feet from smelling?
Try not to wear the same shoes every day. You should have two to three pairs that are worn on alternate days. The accumulated moisture has to be given time to evaporate properly
If you must wear shoes on consecutive days, use a hairdryer, set on medium, for a few minutes to dry out the shoe. Avoid the high setting as it may shrink the leather of the shoe. Also don’t leave shoes by direct heat.
How can I conquer those odiferous tootsies?
- Wash feet every day and dry properly between the toes. This applies after swimming or using the gym.
- Wear clean socks or hosiery every day. Take spare socks if your feet sweat a lot to change into.
- Wear shoes with leather or Gortex uppers. Hard leather shoes retain more moisture than more porous softer leather shoes.
- In general natural materials such as cotton and wool are far better for your feet because natural fibers provide a “wicking” effect which absorbs moisture and keeps the feet cool as your perspiration rapidly evaporates.
- Even more effective are socks made up of synthetic and natural material blends such as Coolmax, Drimax, and Smart Wool which wick sweat away from the skin providing a constant dry layer next to the skin.
- Spray your feet with an antiperspirant deodorant – the type used for underarms.
- Wear open sandals as much as possible in warm weather. For leisure, wear well-made sports sandals.
- If your feet smell, wash them using an antibacterial soap. (If this doesn’t work – see a podiatrist)
- If you use athletes’ foot treatments, follow the instructions properly. Most over-the-counter products need to be used for at least one month (on both feet) for it to be cleared properly.
- At home, go barefoot as much as possible. Those with diabetes should not go barefoot.
- If you use talcum powder, shake off all excess otherwise it ends up as soggy clumps between the toes and makes matters worse!
- Always buy shoes late in the afternoon. Your feet swell throughout the day.
- Be sure to put on both pair of shoes, and walk around the store. Shoes should be comfortable when purchased.
- When possible leave shoes outside in direct hot sun for a few hours as the sunlight helps kill bacteria.
- Activated charcoal insoles (such as Odor Eaters) can help. But you might find some of the following tips more effective:
- Try sprinkling Zeasorb powder into your shoes every day. This powder can be found in your local pharmacy or online. It is a special powder that can absorb 3 times the moisture of regular powder. Plus it does NOT contain corn starch which is often added to skincare powders. Avoid corn starch because it only provides food for bacteria and fungi to feed off of which in turn causes more smell
- Try soaking your feet in tea. Bring 6 to 8 cups of water to a boil and add 4 black tea bags. Remove the water from the heat and, when cool enough, soak your feet in the water for 5 to 10 minutes. The tannic acid found in the tea will temporarily reduce sweat production as well as kill bacteria
What are Swollen Feet?
Swelling is also called edema. Swollen feet are a condition where the muscles in the feet have an excessive buildup of fluid. This buildup can lead to a rapid increase in weight over a short period of time.
Slight swelling of the lower legs commonly occurs in warm summer months. Slight swelling is more likely to occur if a person has been standing or walking a lot.
See a doctor if you have persistent swelling, swelling accompanied by shortness of breath and weight gain, or swelling that damages the skin or if you have specific medical conditions or concerns.
What Causes Feet to Swell?
Swelling is caused by fluid buildup in the tissues. Gravity pulls the fluids to your feet and ankles, causing them to swell. Swelling can be caused by a serious condition of the kidney, heart, liver or blood vessels. Some other causes of swelling are:
- Eating a poor diet high in salt and carbohydrates
- Taking birth control or hormone replacement therapy pills
- Sodium retention
- Muscle injury
- Varicose veins
- History of phlebitis
- Allergic reactions
- Neuromuscular disorders
- Laxative abuse
- Diuretics abuse
- Drug abuse
Can swollen feet be treated?
Treatment will depend on the cause of the swelling. One of the first treatment options is to elevate the legs above the level of the heart. Anti-inflammatory medicine can also help reduce swelling. Other treatment options are
- Leg wedges to elevate the feet while sleeping.
- Support socks and stocking
- Support socks and stockings come in various gradients depending on the pressure needed, and various lengths depending on the level of the edema.
- Proper fitting shoes and socks.
How can I reduce swelling?
- Cut back on salt. Salt contributes to fluid retention.
- Drink plenty of water.
- Put your feet up, lie on your back, rest your feet at least 12 inches above the level of your heart for 10 to 15 minutes, three or four times a day.
- Do not abuse laxatives
- Use support stockings, roll these on in the morning to promote circulation and limit gravitation movement of fluids. Most medical supply or drug stores carry these.
- Exercise regularly. Regular exercise improves circulation.
- Avoid standing in place for long period of time.
- Lose excess weight. Excess weight slows circulation of body fluids and puts extra pressure on your veins.
- Increase muscle activity with walking.
- Avoid long periods of sitting. Every one or two hours, get up and walk.
- Review your medication with your doctors. Certain drugs, including nonsteroidal anti-inflammatories and calcium channel blockers, can contribute to swelling.
Toe deformities, when not treated, can lead to more serious conditions.
One of the first consequences of a toe deformity is a callus or corn formations on pressure sites. If the toe is not treated, then the toes become less mobile and eventually, more serious problems such as skin ulceration and infection may develop.
What are the most common toe deformities?
- Claw toes
- Mallet toes
- Overlapping toes
What Causes Toe Deformities?
There are many reasons why the joints of the toes deform. Babies may be born with toe deformities or in older age, arthritis can slowly destroy the joint surface. A fractured toe that heals in a poor position can also be a problem.
The most common cause of toe deformities in adults is tendon imbalance. This occurs when the natural function of the foot is disrupted through various causes and the tendons try to compensate by stretching or tightening.
No matter what causes a deformity, it is often made worse if you are wearing a badly fitting shoe for a long period of time.
What is the treatment for Toe Deformities?
When conservative treatment fails, many operative procedures can be offered, which do not always achieve a satisfactory result. The best form of treatment is prevention.
If you notice a flat growth on the bottom of your foot, which is usually associated with some pain, it may be a plantar wart. Salicylic acid is the best first line of defense. It is important to get rid of plantar warts quickly to avoid spreading them to others and to other parts of your body.
If you have Foot warts and plan to go swimming, wear a special sock so you don’t spread it to other people. Foot warts can be transmitted through water, so take precautions when walking in the bathroom and near pools. Wearing flip-flops around wet areas is advised.
What are foot warts?
Foot warts are warts that grow on the underside of the foot. The warts are usually about 1cm in diameter. They are a common complaint among children and adults. Sometimes a single wart may have many small warts surrounding it. A single wart with many small warts is called a Mosaic Wart.
Foot warts are often transmitted from one person to another through direct contact to the affected area, in swimming pools, showers and changing areas.
Foot warts are also called Verrucas
What do foot warts look like?
Foot warts look similar to corns. The surface of the foot wart is covered with black dots. The black dots are small blood vessels that feed the verrucae. The color is usually paler than the usual tone of the skin.
What are the symptoms of foot warts?
Some of the most common symptoms of foot warts are:
- feeling like a small stone is under the foot
- pain when squeezed
- pain when direct force is applied to them
What causes foot warts?
Foot warts are caused by the human papillomavirus (HPV). If there is a break, scratch, or a thorn in the skin, the HPV can enter the skin.
Can foot warts be treated?
Yes. Your doctor can prescribe medication and in severe cases, freeze the Foot warts. If you are diabetic or have poor circulation, and believe you have Foot warts, consult your doctor before trying to treat them.
The human foot is a marvel of biomechanical engineering that most of us take for granted until the system fails or breaks down.
Podiatrists who are part of the UCLA Medical Group offer the following tips for helping maintain healthy feet and avoiding complications. The physicians are board-certified, provide comprehensive diagnosis and treatment of all foot and ankle conditions, and also have expertise in the management of diabetic foot problems and sports injuries.
- Inspect your feet regularly and pay attention to changes in color, texture, or appearance.
– Any changes in color and temperature of feet should be reported to a chiropodist and this consultation is important if nails become thick, tough, and discolored.
– Monitoring of Foot corns and peeling of the skin, excessively dry skin is important and needs immediate treatment, preferably with advice from a chiropodist.
– Itchy feet may signal a fungal infection of the skin and doctor’s advice is beneficial for quick relief.
- Press down on the nail of your big toe until the color blanches, then let go. How long does it take for the color to return? If it takes more than 5 seconds, you may have a circulation problem. Talk to your doctor.
- Maintain good foot hygiene, including washing and drying between the toes.
- Hydrate the skin. Summer weather and open shoes can cause a rapid loss of moisture from the skin and may result in cracking or the formation of fissures. It is helpful to replace the moisture content by using lotions or creams on a regular basis. Do not place moisturizing cream in between the toes.
- Buy proper-size shoes. You may not wear the same size in shoes made by different manufacturers. Break them in before wearing them all day. Purchase new shoes late in the day, when feet tend to be at their largest. If your shoes aren’t comfortable at the time you purchase them, chances are they won’t become comfortable. Only buy shoes that feel great right out of the box.
- Don’t ignore foot pain. Symptoms that increase or do not resolve within a reasonable period of time need to be evaluated by your podiatric physician.
- Cut toenails straight across. Never cut into the corner this could cause an ingrown toenail. Gently file away sharp corners or rough edges with an emery board.
– Carrying out any form of bathroom surgery, like cutting out corn with a pair of scissors or picking at the sides of the toenails for dirt with tips of the scissors/nail file can be very dangerous and can lead to further complications for the feet. -Do not pop blisters
– we all want to do it, but it introduces dirt into a tender area of the skin, resulting sometimes in infection.
- Do you push back your cuticles? Healthy ones offer protection from bacteria and infection, but they must be kept from overgrowing.
- Sensation. Run a pencil eraser along the top, bottom, and sides of your feet. Does it feel the same in all four areas? Poor sensation could be a sign of diabetes or nerve injury and should be evaluated by a doctor.
- Exercise. Walking is a great way to keep weight under control and is an excellent conditioner for the feet. Be sure to wear appropriate athletic shoes when exercising.
- Flexibility. Can you pick up a small dish towel and a marble with your toes? If not, you can improve flexibility by massaging your feet and toes gently every day. Also, practice doing the towel and marble pickups daily.
- Alternate your shoes each day. Since the feet have sweat glands, your shoes will absorb moisture from your feet, so it is important to allow your shoes to dry out completely.
– Women who always wear sandals and flat heels can develop fallen arches. On the other hand, continually wearing high heels can also be harmful because the weight of the body is constantly thrown on the toes. A variation in the height of the heels is, therefore, recommended. Look after your shoes, cleaning them regularly and keeping them in good repair, please pay careful attention particularly to the heels and the support you have. Get well-fitting shoes with sufficient space (1/2 inch) between your big toe and the tip.
- Avoid walking barefoot to help protect your feet from injury and infection.
– It is ok to flip flop. If you join a gym, health club, or even are just going to a spa, make sure to take along a pair of flip-flops for post-activity showers. the wet, steamy atmosphere of a gym shower, steam room, Jacuzzi, or even the deck of the lap pool is a great place for bacteria and fungus to breed. This may lead to athlete’s foot and plantar warts. While most spas do provide sanitized sandals, I always love the fit, comfort, and security of bringing my own.
– Do wear sandals and slippers around your house. In addition, do remove your outside shoes prior to entering your home the germs, bacteria and other pollutants that your shoes pick up during the day in parking lots, restrooms and other unsanitary places should not be brought into your home environment. Do wash your hands after handling the soles of your shoes.
- Put sunblock on your feet while wearing sandals during the day to avoid sunburn.
- Pampering as Prevention. Take a trip to the day spa for some foot pampering. It is important to pamper the feet if we expect them to keep up with our daily regimen, in addition to this soak your feet a few times per week to keep skin soft and refreshed. I like to soak them while I shower by stopping up the drain and then following with a foot file or pumice stone buff over the touch skin areas. This will help prevent the painful buildup of dead skin and calluses and allow healthy skin underneath to get moisture.
Most of us know we should exercise our bodies, yet we forget to exercise our feet.
Regular foot exercise is extremely important. Remember, there are about 19 basic muscles in the feet and about 18 are attached to the toes. Especially in the case of the people who keep wearing shoes for a long time in the day, the toes are not able to move freely. As a result, the feet become weak and vulnerable. Foot exercise comes in here for the rescue of your feet. The more exercise you do with your feet and toes, the better and stronger, they will become and we all need a firm foundation.
Sit with legs crossed. Rotate the feet six times towards each other and six times away from each other.
Move the foot up and down in a rhythmic manner by abridging the calf and shin muscles. Do this exercise at regular time intervals for about two to three minutes a day.
Put a small towel on the floor and curl it towards you with just the toes. Do this increase with increased resistance levels by keeping your weight at the end of the towel. Relax for some while and start again. Do the process at least five times.
Toe Raises, Toe Curls
Sit with legs stretched, straight out in front. Bend the toes up as far as possible and then down as far as possible. Do each position and hold for about 5 seconds. Repeat the act about 10 times.
Big Toe Pulls
Put a thick rubber band about both big toes. Pull the big toes away from each other. Hold in this position for about 5 seconds. Repeat them for around 10 times.
Put a thick rubber band around all of your toes and spread them. Be in this position for a few seconds. Do the same act for about 10 times.
Put small corks or toe separators in between your toes and compress them for some seconds. Do 10 repetitions.
Marble Pick Up
Put 20 marbles on the surface. Start picking up one marble using your toes and place it into a bowl. Continue until you have picked all the marbles up.
Pick Up Sticks
Put a pencil on the floor and try to pick it up with your toes. This will strengthen the feet.
The Golf Ball Roll
The golf ball roll is to roll a golf ball under the ball of your foot for about two minutes. It is a great way of doing massage on the bottom of your foot. It is best applicable for the people who have plantar fasciitis, i.e. heel pain syndrome, cramps, or strain.
Spread um Dano
Sit on a chair with feet on the floor and spread out the toes as far as you can. This will tone up the feet muscles.
Sand walking is the best exercise for your foot. It is suggested that whenever you get the opportunity to be near the sand, just take off your shoes and begin to take a walk on the sand at the beach. Sand walking not only provides a great massage to your feet; it also strengthens your toes and gives overall foot conditioning.
Though there are a good number of foot-exercise that medical professionals recommend, you should do the ones that your orthopedic surgeon and physical therapist recommend you. He or she may tell you that you should exercise about 20 to 30 minutes at the regular intervals of days, if not daily.
Steps for a Relaxing Foot Massage
A foot massage can be performed any time your feet need a relaxing break. These standard foot massage techniques that a nail technician might perform on a client during a pedicure can be used on yourself or a loved one. Relax, wear loose, comfortable clothes, and sit comfortably with your back supported.
For massage, you’ll need a massage lotion or you can use these calming oils blended together:
• 2 teaspoons (10 ml) castor, jojoba, soybean, or extra-virgin olive oil
• 3 drops lavender essential oil
• 1 drop German chamomile essential oil
• 1 drop geranium essential oil
Combine all the ingredients in a small bowl. Stir thoroughly. Yields 1 treatment.
- Start by relaxing your foot. Hold your foot so that one hand is on the sole and one on the top. If using massage oil or lotion, protect clothing and furniture with a towel or two. Rub oiled or creamed hands together vigorously to warm them before beginning the foot massage. Working from your ankle to your toes. Massages it with long, firm strokes. Stroking stimulates circulation and warms the foot.
- Holding your heel in one hand and your toes in the other circle your foot five times clockwise then anticlockwise. This will loosen the joints and relax the foot.
- Starting with your big toe, stroke the length of each toe in turn and, when you reach the tip, pull gently to stretch it out. Repeat this three times. Pulls and Squeezes can be very calming.
- Using our thumb in an inchworm movement and starting at your big toe move along the line of pads just below your toes. Press on each one firmly before moving on to the next. Work your way to your little toe, then change hands and, using your other thumb, work your way back. Repeat twice.
- Use your thumb to press down gently from the top to the base of your big toe. Repeat on all of your toes. When you reach your little toe, change hands and use the other thumb to go back the other way. Repeat twice.
- Holding your toes in one hand, use your thumb, on the other hand, to press along the sole, pressing in a line from the base of your big toe to the center of your foot, following the line of the metatarsal. Repeat on all your toes, and then repeat on the top of your foot following the same line. This will help in releasing tension in the inner and outer longitudinal arches.
- Starting at your heel, use your thumb to press along the inside edge of your foot all the way up to your big toe. Press firmly and follow the line up over your instep. Then repeat on the outside edge of your foot, from your heel to your little toe.
- Finally, massage the lower half of your sole, using firm pressure. Rotate your ankle, both clockwise and anticlockwise, as in step 2. Repeat step 1, using long, firm strokes from ankle to toes. Put on a cotton sock and repeat the massage on the other foot.
Pedicures are great ways to give your feet a well-deserved, pampering deep cleaning. Most people love the pampering and relaxed feeling that accompanies a pedicure. However, your pedicure can turn into a nightmare if the footbath is not cleaned properly. When footbaths aren’t cleaned and disinfected properly, skin can gather in the tub basin, drain, and aqua jets; and bacteria can grow to unusually high levels.
If the footbath is improperly cleaned, it may contain bacteria called mycobacterium fortuitum or other types of fungi.
Symptoms of a Mycobacterium fortuitum Infection
Some of the most common symptoms of a mycobacterium infection are boils that usually start out looking like a spider bite but gradually grow in size, eventually producing pus.
Can a Mycobacterium fortuitum Infection be treated?
Yes. The infection can be treated with antibiotics and some boils will heal on their own. Treatment may require several weeks to complete. Depending on the severity, treatment may include multiple rounds of antibiotics lasting up to several months.
Tips for getting a Safe Pedicure?
We discussed this in great detail last week in the Nail Issue of Spavelous “Now You are In The Know” here is a brief overview:
- Ask the manager how often the footbaths are cleaned. The footbaths should be cleaned at least once a day. The bacteria is usually present in the filter. The filter should be removed and free from debris. Ask to see the filter to make sure it is clean.
- Ask the manager how the footbaths are cleaned. The footbaths should be cleaned with a bleach solution for 15 minutes.
- Don’t shave your legs 24 hours before your pedicure. A shave can create tiny nicks that allow the bacteria to enter your skin.
- Make sure the salon sterilizes metal equipment between appointments. Some salons will allow you to bring your own metal equipment. Or bring your own equipment.
- Make sure the salon has posted a current license from the Board of Cosmetology, as well as the Board’s Health and Safety poster.
- Make sure your pedicurist has posted their license.
- Trim only your toenails. Do not let your pedicurist cut your cuticles. Cut cuticles provide an opening to bacteria.
- If the footbath basin looks dirty, ask your pedicurist to wash and disinfect the footbath and the metal equipment. If you have any concerns. Leave it is not worth the risk.
Types of Pedicures
There are various different types of pedicures. Some of the most common types are as follows (names and products may vary from spa to spa):
Regular Pedicure: This is a simple treatment that includes foot soaking, foot scrubbing with a pumice stone or foot file, nail clipping, nail shaping, foot and calf massage, moisturizer, and nail polishing.
Spa Pedicure: Includes the regular pedicure and generally adds one of the following: Paraffin dip, masks, mud or seaweed treatment.
Paraffin Pedicure: This is a treatment that includes a regular pedicure but also includes the use of paraffin wax. The feet are covered with layers of paraffin wax to moisturize feet.
Stone Pedicure: This is basically a foot massage that involves the use of various different essential oils that are rubbed with the help of hot stones for the massage of the feet and legs.
French Pedicure: It is a regular pedicure that involves the use of white polish on the nail tips with a sheer pink color on the base.
Mini Pedicure: This focuses mainly on the toes with a quick soak, nail shaping, and polish, but does not include the massage or sole care. This is designed for an appointment between regular pedicures for generally well-maintained feet.
Athletic Pedicure: This is a regular pedicure for men or woman, it does include either a clear polish or just toenail buffing. Usually, the aromatics used will be more cooling like peppermint, cucumber, or eucalyptus.
Chocolate Pedicure: A regular pedicure that may include a chocolate foot soak, chocolate foot mask, or chocolate moisturizing lotion.
Ice Cream Pedicure: A Regular Pedicure where you choose your Bath ball which looks like a scoop of ice cream. The soak is followed with a foot scrub usually in (Vanilla, Chocolate, or Strawberry) And topped with a whipped moisturizing lotion, cherry red polish tops it off.
Margarita Pedicure: This is a regular pedicure which includes a salt scrub, lime soaking water with fresh limes, a lime-based massage oil and moisturizer.
Champagne or Wine Pedicure: This is a regular pedicure usually featuring a grape seed scrub, grape mask peel, and finished off with a grape seed oil or moisturizing massage.
Foot Loose and Fancy-Free
The time to take a look at your feet is now, determine what conditions you have and how best to handle it should begin prior to sandal season. If you are not sure what problems you have, seek the advice of a professional like a nail technician or a podiatrist. You may have noticed that I did not give instructions for a home pedicure. This is because most pedicures are reasonably priced and as long as you are not a long-distance runner or a tennis player (both are hard on their feet), a professional pedicure will last 6 – 8 weeks. Do your daily maintenance of foot soaking, light pumice stonework, thorough drying, proper moisturizing, and shoe rotation, and your feet will always be Spavelous. If you do not have a local nail technician, use Spavelous to locate a spa near you.